A Family Navigator Intervention to Improve ADHD- Related Treatment Adherence (I2-ART) for Minority Children

家庭导航干预可提高少数民族儿童 ADHD 相关治疗依从性 (I2-ART)

• 批准号: 10308494
• 负责人: Kelly Kamimura-Nishimura
• 金额: $ 19.02万
• 依托单位: CINCINNATI CHILDRENS HOSP MED CTR
• 依托单位国家: 美国
• 财政年份: 2020
• 资助国家: 美国
• 起止时间: 2020-12-01 至 2025-11-30
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10308494
• 关键词: Address; Adherence; Advocacy; African American; Area; Attention deficit hyperactivity disorder; Behavior; Behavior Disorders; Behavior Therapy; Behavioral; Behavioral Model; Belief; Caregivers; Caring; Child; Childhood; Clinical; Clinical Research; Clinical Trials; Clinical Trials Design; Communities; Data; Development; Development Plans; Developmental Disabilities; Elements; Environment; Evidence based intervention; Evidence based treatment; Faculty; Failure; Family; Feedback; Feeling; Focus Groups; Funding; Goals; Grant; Guidelines; Health Personnel; Health Services Accessibility; Healthcare; Healthcare Systems; Impairment; Improve Access; Intervention; K-Series Research Career Programs; Latinx; Latinx population; Link; Literature; Manuals; Manuscripts; Mental Health; Mental Health Services; Mentorship; Methodology; Minority; Minority Groups; Modeling; Modification; Motivation; National Institute of Mental Health; Neurodevelopmental Disorder; Outcome; Parent-Child Relations; Parents; Pediatric Hospitals; Perception; Pharmaceutical Preparations; Phase; Population; Positioning Attribute; Productivity; Qualitative Methods; Randomized Controlled Trials; Research; Research Personnel; Source; Stimulant; Symptoms; Testing; Training; Trust; Uncertainty; Underserved Population; United States National Institutes of Health; Writing; Youth; acceptability and feasibility; behavioral outcome; career development; cohort; community partnership; design; distrust; empowerment; experience; health care disparity; health disparity; improved; medication compliance; medication nonadherence; member; minority children; motor vehicle injury; navigator intervention; novel; patient oriented; pediatrician; racial and ethnic disparities; research clinical testing; side effect; symptom treatment; therapy development; treatment adherence; treatment as usual; treatment planning; work-study

PROJECT SUMMARY/ABSTRACT I am a developmental-behavioral pediatrician who has earned an MS in Clinical Research. My long-term goal is to become an independent researcher focused on advancing developmental-behavioral outcomes of children from diverse, underserved groups by improving their adherence to treatment plans for mental health conditions, including attention-deficit hyperactivity disorder (ADHD). My current objective, which represents the next step in pursuit of this goal, is to develop a culturally-tailored family navigator Intervention to Improve ADHD-Related Treatment adherence (I2-ART) for minority children using a systematic, patient-centered, iterative approach consistent with the ORBIT model for behavioral intervention development. Key elements of the career development plan to support both my long-term goal and current objective include training in (1) the design and evaluation of clinical and mental health services trials to improve treatment adherence, (2) health disparities and community-partnered research, and (3) effective grant and manuscript writing. My mentorship team includes NIH-funded investigators with expertise in ADHD, clinical trial design, treatment adherence, health disparities, and community-partnership research. Furthermore, Cincinnati Children’s Hospital, which ranks #2 among U.S. children’s hospitals for NIH funding, provides an outstanding research environment and strong support for junior faculty, including >30 current recipients of NIH Career Development Awards. Proposed Research: ADHD is the most common pediatric neurodevelopmental disorder and is associated with significant long-term impairments. Current guidelines recommend stimulant medication and/or behavioral therapy as first-line treatments for ADHD. Despite evidence that consistent treatment is important for effectively managing ADHD symptoms, treatment adherence remains suboptimal and is especially problematic among minority children. Hypothesized reasons for racial/ethnic disparities in ADHD treatment include uncertainties about medication efficacy and side effects, distrust of the health care system, and decreased access to mental health services. This study aims to develop and test the I2-ART intervention to improve treatment adherence in minority (Latinx and African American) children with ADHD. The proposed study involves three ORBIT phases: During phase 1a, we will conduct focus groups with key stakeholders (i.e., caregivers, clinicians, and family navigators, n=24) to identify and develop I2-ART’s basic elements. Next, during phase 1b, we will train four family navigators to implement I2-ART with caregivers of treatment-naïve children with ADHD (n=8-12) in order to determine feasibility and acceptability. In phase 2, we will use phase 1b findings to modify I2-ART as needed, and then will evaluate the preliminary efficacy of the revised I2-ART (n=40), compared to the “usual care” control condition (n=20), on ADHD treatment adherence. The preliminary data collected during the proposed study will inform a subsequent R01 randomized controlled trial to examine I2-ART efficacy.

项目概要/摘要 我是一名发育行为儿科医生，获得了临床研究硕士学位。我的长期目标 是成为一名独立研究人员，专注于促进发展行为结果 通过提高来自不同、服务水平低下群体的儿童对心理健康治疗计划的依从性 疾病，包括注意力缺陷多动障碍（ADHD）。我当前的目标，代表 为实现这一目标，下一步是开发一款适合文化的家庭导航仪“干预改善” 使用系统的、以患者为中心的、针对少数民族儿童的 ADHD 相关治疗依从性 (I2-ART) 与行为干预开发的 ORBIT 模型一致的迭代方法。的关键要素 支持我的长期目标和当前目标的职业发展计划包括 (1) 设计和评估临床和心理健康服务试验，以提高治疗依从性，(2) 健康 差异和社区合作研究，以及（3）有效的资助和手稿写作。我的指导 团队包括 NIH 资助的研究人员，他们在 ADHD、临床试验设计、治疗依从性、 健康差异和社区伙伴关系研究。此外，辛辛那提儿童医院 在美国国立卫生研究院资助的美国儿童医院中排名第二，提供出色的研究环境 对初级教师的大力支持，包括超过 30 名目前获得 NIH 职业发展奖的人。 拟议的研究：多动症是最常见的儿科神经发育障碍，与 重大的长期损害。目前的指南建议使用兴奋剂药物和/或行为 疗法作为 ADHD 的一线治疗方法。尽管有证据表明持续治疗对于有效治疗很重要 管理多动症症状时，治疗依从性仍然不理想，尤其是在以下人群中： 少数民族儿童。 ADHD 治疗中种族/民族差异的假设原因包括不确定性 关于药物疗效和副作用、对医疗保健系统的不信任以及获得精神援助的机会减少 卫生服务。本研究旨在开发和测试 I2-ART 干预措施，以提高治疗依从性 少数族裔（拉丁裔和非裔美国人）患有多动症的儿童。拟议的研究涉及三个 ORBIT 阶段： 在第 1a 阶段，我们将与主要利益相关者（即护理人员、临床医生和家庭）开展焦点小组讨论 导航员，n=24）来识别和开发 I2-ART 的基本元素。接下来，在第 1b 阶段，我们将训练四个 家庭引导者与未经治疗的 ADHD 儿童 (n=8-12) 的护理人员一起实施 I2-ART，以便按顺序进行 以确定可行性和可接受性。在第 2 阶段，我们将使用第 1b 阶段的发现将 I2-ART 修改为 需要，然后将评估修订后的 I2-ART (n=40) 与“通常的 I2-ART”相比的初步疗效 护理”控制条件（n = 20），关于多动症治疗的依从性。在研究期间收集的初步数据 拟议的研究将为随后的 R01 随机对照试验提供信息，以检查 I2-ART 疗效。